Treatment of endoscopic esophageal perforation

Background: The increasing usage of flexible endoscopy leads to a higher in cidence of esophageal perforations, whose treatment strategies (conservativ e or operative) still are discussed controversially. We present our experie nces and therapy concepts in relation to 75 iatrogenic esophageal perforati ons. Patients: Between 1983 and 1997, 75 patients were treated for endoscopic pe rforation of the esophagus. The gender distribution was 31 females (41.3%) and 44 males (58.7%), with a mean age of 64.4 years (range 2-90 years). Results: Therapeutic endoscopy was the most common cause of perforation (73 of 75 patients; 97.3%). Diagnostic endoscopy caused perforation in 2 patie nts (2.7%). The perforation was located in the cervical part of the esophag us in 7 patients (9.3%), the intrathoracic part in 25 patients (33.3%), and the abdominal part in 43 patients (57.3%). In this study population, 25 pa tients (33.3%) were treated surgically, and 50 patients (66.7%) conservativ ely. The overall in-hospital mortality rate was 14 of 75 patients (18.7%). In the surgically treated group the rate was 6 of 25 patients (24%) and in the conservative group 8 of 50 patients (16%). Conclusions: The decision of a treatment strategy depends on different fact ors such as the location and extent of the injury, the time interval betwee n perforation and treatment onset, the preexisting diseases, and the patien t's general condition. In view of these factors, an individual therapy conc ept should be determined for every patient.